meeep

I'll go ahead and apologize for this post in advance. I mostly wrote this over the course of a month and kept self-editing the crap I wrote while sleep deprived. I'm still running on very minimal sleep and a recent change to night-shift for the new job (just keep reading) . I've been gone for a while, and it was mostly due to a self-imposed writer's block (sorry but not sorry). I tried to write several posts over the last two years but ended up instead diving deep into the comments that mainly came from Russians and have nothing to do with healthcare at all (SEO I guess?). I spent many days wondering if I should just delete the comments and move on, but now I'm fascinated (and by fascinated I mean obsessed and wasted far too much mental thought for an average adult on it). If you're reading this in Russia, and got redirected from a search engine, hello from America and thanks for Nov 2016 (sarcasm ). Also, I didn't really love the idea of coworkers/the hospital knowing I write a blog about my job. I've only had one person ever figure it out, and it kind of freaked me out a little. I've gone through varying stages of deleting the blog all together now, but for now I'll keep it full code.

Now that I've gotten my usual disclaimer out about not writing in forever etc etc- I'll try to sum up things in this paragraph. I probably should have lead with this, oh well. I got engaged, married, started working nicu against my better judgement, became severely over-worked (+ seven years cvicu) and underpaid for the experience/workload I was given on daily basis. This resulted in making me a bitter and jaded RT after all the years of trying to avoid that. Luckily, I finally realized I was worth WAY more around January 2018 and made a resolution to follow my goals that I had long forgotten about, applied for a transfer, and one monthish later I was working on a different campus and got a chance to join the ecmo specialist team (it's so crazy sexy cool). Plus I'm  FINALLY going back to school in the fall to finish the bsrt. I'm still contemplating PA school, but as I've already spent many blog posts on the subject- I'll just say it's more of a pipe dream that would drown me in student debt. If anyone has a spare 90K they'd like to donate to me I would be applying to programs tomorrow...

It's almost been a year since I've left the last hospital I had worked for (7 years), and at first I was SO glad to get away from the daily draining workloads and my director that was allergic to accountability and progress. The real irony is that I accepted this new job right as that director decided to retire. Even if I had known that there would be a shake up with management I really doubt that would have changed my mind about applying for another job. I hit a breaking point HARD one week in the fall of '17. Maybe I'll try to summarize the story later if the PTSD ever subsides.

I thought about how to explain why I stayed for so long at the last hospital (masochism is still the top theory). But the biggest factor was that I had based too much of my self-esteem and worth from my job and I got comfortable with my corner. Seven years is a lot of time to build trust with all the attendings, nurses, mid-levels, fellow RTs, techs, etc. and that's pure bullion in my book. Other reasons were: our dept was very well respected and autonomous in all of the units (it's rare, I know), my coworkers in my department became a second family to me, I had complete knowledge of all of the best shortcut stairwells to go stealth mode, and the commute was only ten minutes in Atlanta (the rarest perk of that job I took for granted).

Despite all the good...

My husband really was the voice of reason for helping me to leave the last hospital. He reminded me that most people don't leave work wanting to lock themselves in the bathroom with some wine/music for 45 minutes due to the insane physical and mental olympics I'd have to deal with daily just to calm down so I could interact with my husband and dogs after work. I would also waste too much time crying over bullshit politics that I wanted nothing to do with but somehow would be stuck despite staying far away from enemy lines. I WANTED TO BE SWITZERLAND. So many problems I've seen working in a hospital could be improved if egos could be set aside and we all worked on mutual respect and communication. Oh, and I want a pony, too.

I have MAD respect for night-shifters now. No, I haven't figured out how to sleep during the day. Yes, I've been doing it almost a year without having a complete psychotic break. The only thing that I can say for certain is I cannot do the three night stretch. Two on, one off so I can catch up on sleep, and then I'll work the third so no one gets hurt.

I am happier with the new job when it comes down to assignments. I have really enjoyed getting to pee multiple times in a shift and occasionally I can read a book.  Too be fair, it's really a different work flow when I have a 1:1 ecmo, so it kind of balances out the hectic days where I'm just in the RT staffing for icu. It's 2019 and my softcore resolution is to be grateful of the things I love about my job so I'll just stop right there. Also, please don't be a dick to anyone.

I'm about to pass out from working the last 4 nights, but I promise I'll put out another post soon enough with some funny stories (and maybe the story about my breaking point from fall '17) when my brain isn't about to turn off.

One ticket to suckville

I'm beat down tonight. It was just one of those days. Really sad cases keep rolling in, and the cherry on top was a heavy assignment with new admits and transports. It's so hard for us healthcare workers to know what's really going on with a patient behind the "white curtain" of information (sugar coating prognoses), and then seeing a hopeful family leaning over their mom's bed because her heart is still beating. C'est la vie, non?

On a lighter note...

More observations from yours truly recently:
1. When you don't have a hemastat, that's when you need one.
2. OR admits in CVICU happen most frequently at shift change, and never spaced apart.
3. The cafeteria has surprisingly good chicken wings.
4. Healthcare workers are paid to be inadvertent sadomasochists. 
5. It only takes one time to get run over on transport before you watch where your feet are in proximity to wheels rolling.
6. Don't like a particular RN? Guess who has the patient that's been coding all day??
7. Eat your veggies so you don't get a bowl obstruction so large that... well you know the rest.
8. Med students always ask to shadow me on the days that I am doing noooothing interesting.

And fin. I've got two more two more days until vaaaacation and I'm quite ecstatic!

Later gators.

RRT to PA revisited, again.

My brain is pretty much jammed to maximum capacity on getting into PA schools right now. I had the flu (yeah yeah, the flu shot worked soooo well this year...), and an over-abundance of free time that I was quarantined at home to commit to researching pa programs even more than I have before. Commenting on the flu: I haven't had it as an adult so I wasn't really sure what to expect other than suckville. I do think I had a relatively mild case (fever never went over 101 and resp symptoms were minimal. tamiflu started asap). Just a dry cough and really really tired all the time (think Mono-esque). I suppose I've been spending a good bit of time thinking about my life plans (with fiance too), and I really knew I had to get back to school soon. As it stands I've been in the field for about 4 years, and the bang-my-head-on-walls quota goes up every time I roll into work. I know PA school isn't really my only option, but it's the one I've consistently come back to time and time again. Life's too short to not at least try to achieve your goals, right?

So, here goes. I am giving myself the next 2ish years to get all the prereqs done (one Chem will need to be repeated bc I took it forever ago), and finish up my BsRT. The different programs I'm interested in are basically all within the south east, but Mercer and Emory being the top two because they will not require an uprooting of life for me. I'm trying to figure out which programs lean more on healthcare experience #'s rather than the fresh-out-of-BS-in-chem-miss-4.0gpa-22yr old (didn't get into med school)  that lists "healthcare experience" as a medical assistant in her father's practice (really, this person isn't a joke) for 500 hrs. It's just gotten so competitive to apply for these programs that prior healthcare experience isn't the first thing that's considered anymore. So much so that GPA/GRE need to seriously be above the 3.5/300 range to even have a smidgen of a chance. I do get reasoning behind this shift to focusing on academics with all the intense didactic science that you get thrown at you the first year for diet med school. Applicants need to at least prove that they are capable of handling the a&ps and pharmacology. In some way, I think NPs might have an advantage in my head because they at LEAST had a yr of clinical + 1 yr bedside RN work BEDSIDE. The RT gods would strike me down with lightening bolts if I said that statement aloud. The real truth of that statement also leads back to nursing leaving the breathing/vents/breath sounds/abg interpretation to RT & MDs. Which, is to say that most of the nurse practitioners I've worked with in the last 4 years have been quite humble and asked for my opinions/suggestions on patient care bc they outsourced that shit to RT. But the flip side is I also work with a STELLAR PA that was a RT in past life, so my encounters with her are always fantastic. Eh, kind of conflicting opinions, but I do know that I have to adapt to the rah-rah-PAs-are the-best-go-team attitude before interviews.

Here are the other weird things that I have used my excellent detective skills to uncover:
1. If the interviewers ask you your favorite TV show, do not say Grey's Anatomy. The Wire is my number one choice, followed by Scrubs, GOT, and Always Sunny (the early years). My choices are affirmed by McNulty's bad-assness, JD and Turk bromance, Game of Thrones because, damn, I read ALL of those 1k page epic books, and Always Sunny due to Charlie Day and the night man commeth.
2. I swear, the PA students are basically all hot. Even on par with ENT resident hotness. Is this an unknown boost to applications?
3.  Apparently the CASPA application is as long and as detailed as Game of Thrones novels, so I've got that going for me...
4. The personal statements I read so far are chalk full of cliches. I know, I use a fair amount on my blogs as well, but I'm pretty good at editing it out of final drafts.
5. Speaking of personal statements, I think I'm just going to outline how excellent my skills of survival would be during a zombie apocalypse. I do live in Atlanta, just sayin. I'm also always prepared for many emergencies. Maybe I'll think on this one again.
6. Do not rag on MDs for not spending much time with their patients. Because it might be and MD that asks you a question pertaining to why you chose PA over Med schoool... Don't be that guy.
7. Seven is closer to heaven. This doesn't have any real meaning for applying, I just always say that to myself when I park on the 7th floor in the deck, or work all day on 71 floor. And zone out for the list at 7.
8. Try to make your application well rounded, and not your body shape. Seriously. I still don't know why or how all the current students are so damn pretty.
9. You can always re-take classes and explain bad GPA, but you must REALLY outshine in every other category and show epic improvement recently in school grades. At least good enough to score an interview and impress them with all the prettiness you can produce.
10. Ten is the end.

Night night.

...It's been awhile

I know, I know. It's been ages. This is just that time of year where the whole hospital is on diversion and staffing is depleted because, SURPRISE, everyone gets sick from being over worked, and oh yeah, working with sick people. Moral is borderline through this time of year to say the least, so why not work all the holidays too!

Bright side is that I got engaged! I finally caught a boy! Time to break out the ball and chain I've been hiding in my closet and secure it firmly to his ankle. Hah. He prob doesn't quite find this as humorous as I do. I now have a pinterest problem that is borderline unhealthy, but sooo much fun until I get the calculator out and adding up costs of a wedding.

Since the last post was the most depressing thing I've ever dealt with at the hospital I will do all of us a favor and write some funny/dumb things I've encountered lately.

Here's a good one from today. Back-story: I was working in a post-op CT surgery icu (open hearts etc) admitting patients/running around doing a million things at once. We have a set protocol for vent settings/weaning/extubating these patients (so variations on vent settings have to be ordered). I was admitting a straightforward case this afternoon w/ the RN and a bright and shining NP student was bagging while I got the vent ready...

Baby NP: Did you get my settings?
Me: Yeah (they were written on report sheet).
Baby NP: Well, I have the peep at 8.
Me: Okay. Because they are bleeding?
Baby NP: No, I don't think so. Wait. Let me check. Just go ahead and change it.
Me: Did you have oxygenation issues in the OR?
Baby NP: No. Are you going to change the peep now? Well, let me just do it for you.
Me: Nooooope. (at this point I'm annoyed and not entirely sure she knows what peep really does, and I go stand in front of the vent and write down some numbers).
Anesthesia fellow: Well, Baby NP, what's your reasoning behind higher peep right now? (we are all now trying to figure out rational).
Baby NP: I am just following evidence based medicine.
Me: Which paper are you referencing?
Baby NP: ....uuuuh...
Attending: Okay, Baby NP, why don't you go make copies of the report sheet for everyone (a fools errand bc 1. we all have sheets anyway and 2. good luck finding our copy machine password).

As soon as they walk out of the room in search of the impossible copier we bust out in uncontrollable laughter. Attending for the score!Lesson: Don't be a cocky student. And DEFINITELY don't be a cocky student that has no idea what they are talking about. The rest of the day all the doctors asked me to turn up the peep on non-intubated patients. We laughed, but in reality the scary thing is that at some point that NP will be taking care of really sick people. Hopefully the Baby NP will find some humility soon...

Fibromyalgia. I added that one onto the list of patients that I don't trust (along side of patients with multiple multiple allergies to things like gluten, Ibprofen, tylenol, ultram, cilantro, and all kinds of tape). I think it's the perfect diagnosis for hypochondriacs. Juuuust an observation.

Anywho. Bedtime for this lady. More fun awaits me in the morning.

Listen

I'm kind of at a blank on how to begin writing this post today. It's hump day, and I've spent most of it on the couch reading some horribly offensive young adult novel about categorizing citizens blah blah blah. I guess it made for some interesting dreams last night with crazy people chasing me with guns and sappy love stories that included someone referring to me as "Lucky Charms." I guess it's a play on my Irish name of origin, and as he so boldly put it in the dream, "...Lucky Charms, because you're magically delicious." Yeah, even my subconscious is weird.

I started to write a post a few weeks ago about this really bad night at work. I walked out of that code that night with a red hot face that was bursting with anger, and tears that were so heavy that they just collected in my eyelashes before dropping down my cheek. Completely lost my shit. In response to try and deal with it all, I started writing a new blog entree to relieve the festering anger and allow me to sleep, but all that came out on paper was a bunch of childish comments and sarcasm to cover up how much that night hurt.

I'm glad I didn't post that rant, because I just read it over again and I can honestly say that I sounded like a brat. I was writing to vent (yes pun intended). Now I'm a little more rational but I still need to write about it. With that in mind, the specific details of the code are really miscellaneous. However I will say that I tried to tell the MD three times over that this patient needed x, y, z and to page ENT, oh about 3 hrs ago. The MD did not listen to my suggestions, and the result was a code blue nightmare that left me raging with guilt.

Guilt because I had failed to help keep this patient from harm. Anger because my voice was silenced without consideration. It was only in the desperate moments at the end of everything that they finally listened to me, but at that point it was really too late. All I could do that night was cry behind the ABG lab door for a few minutes, compose myself and then get on with work.

After retrospection and some counseling from my sage adviser I calmed down from the moment. It took a few days for the emotions to subside completely. I don't break down often at work, so it kind of shocked me when I couldn't let this one go. I get irritated at coworkers all the time, and use those moments to remind me that I am not a prisoner of my job; it motivates me to get my ass in gear and go back to school. But this code was different. I couldn't use a patient's death to spark my inspiration to take Chemistry in the fall. It felt like a cheap way to deal with it.

I don't want to fall into the trap of going to PA school just so I can be the decider and write all of the orders. It has to be so much more than that. I know I make mistakes. I know I am not always right. Disagreeing happens. What I find respectful in a practitioner is one that will listen to my argument, say no, but then give a justifiable answer for the decision as to why they don't agree.

Sometimes it is hard as a RT to remember that we are really there to follow MDs orders. That no matter how much value we have in critical care, all of that, is easily forgotten when up against a practitioner's inexperience/ego/stubbornness. It hurts our esteem as qualified members of critical care when our suggestion is met with a blank stare, and shot down without consideration. Every time I move up to the Esteem rung on the Maslow's hierarchy of needs pyramid, an event like this one threatens to bump me off again. I really think that is why so many of us burn out. Most of the time it is a thankless job, and I know for me it is very hard to gain that self-esteem back when I am not respected in my profession. Over, and over and over again.

I wanted to go talk to that MD after the code so badly, and have the "I told you so" moment. I felt like it would make me feel better or give me a taste of validation. I also thought about writing them up for a litany of reasons in the name of patient safety. But I didn't. I'd like to say it was because I took the high road, but really it was just to avoid confrontation because I was still so upset.

I suppose I'm still hanging on to it a little, still trying to process that night. I guess I'm still human. Thanks for listening.

sick

Strange to think of it this way, but...

Please learn to work in a hospital while you are sick. Just go ahead and accept that. I'm not joking. I have learned over the last few years of work that calling in sick/out for family/life issues will cost you dearly. I'm not saying this from a bitter perspective; rather one to help new grads/new hires realize where they sit in the caste system of your department. The punishment will come in several different manifestations, but the end result will be the same; emotionally draining. Because, honestly, we don't get enough of that as is. I've put together a list of things to help you as a newbie, that I've had to learn the hard way:

1. Learn your attendance policy backward, forward, and every space in between. Seriously, look it up, print it out, and know what is expected of you.

2. Get the flu shot. Period. Don't even argue on it.

3. Find someone at work to be your go-to for switching shifts. I've saved myself a few sick days just merely asking a co-worker to switch and give me an extra day to rest when I'm sick.

4. IF you are throwing up, running a raging temp, coughing up phlegm buckets, or have a hemorrhagic viral infection ( ie, Ebola), do not go to work, and do not let anyone make you feel bad for calling out. Remember that you are involved in direct patient contact, and any of your harmful germs could really push a very ill patient over the edge.

5. Stay on top of getting your licence renewed. CEU's creep up on you reaaaaally fast when they are due.

6. Get a reliable car, but make sure it's with in your means.

7. Zyrtec in the spring, airborne in the fall.

8. Yoga/meditation for your mental health. That's very important too.


Switching subjects, because I'm so great at that...

I'm actually enjoying my new shift. It's not a huge change (right now I work from 3-11pm, and 11am-11pm), but it really makes a big difference: 11am-7pm. I'm in love. I still get to sleep in, and also leave work at an earlier hour so I can work out/get groceries/socialize with normal people.

It can sometimes require a lot of flexibility. I spent the first four hours helping out coworkers cover lunch and/or recovering the CABG/heart patients that roll out of surgery and then I pick up an assignment at 3pm to cover the Q4 vent checks in an ICU until the night shift crew rolls in. Sometimes I find myself not really getting a break in all of the switches, but I generally am in a much better mood since it means I get to leave early.

This summer is going to bitter sweet when it comes to work. A few of my favorite co-workers are finishing up their masters degrees and will be out on the hunt for new jobs. I'm really happy for them with all of their new opportunities, but I am sad that I won't have my good friends to joke around with anymore. Like I said, bitter sweet.

Anywho. This pollen is raping my face yet again. Spring time is killing me right now.

One last little fun bit.... One of the attendings at work dropped this one-liner that had me in stitches. "How about you get the orders from your BRAIN".

Bored

Today is a bit rare. I actually have some time to write on this here ole blog thing. Well, maybe I've had time here and there, but between sleeping and complaining I kept putting it off.

Here's the current list of complaints: my back hurts, heavy ass work assignments, zero interest in budgeting my monies effectively, bills, no trips on the horizon, patients asking for stupid things, AOS (attending over-ordering syndrome), brand new impossible charting standards, cold weather, other people's weddings that bogart my time off, lack of desire to work out, days off that are spent running errands/cleaning, and just that circular grind that happens as soon as you get a big girl job.

I walked outside this past Sunday into sunlight in a t-shirt for the first time this year. I think that's probably the most cheerful I've been in a while. I'm pretty sure it's just burn out and being over-worked that's kept me down. I even tried a "stay-cation" to help re-set my mind, but all that ended up happening was far too much netflix watching and doing a whole lot of nothing. It was quite nice, but I also feel guilty because I had multiple adult-like responsibilities to get done and...nada.

I knew burn out would eventually happen in this profession. Sure, there's way more I could learn and work towards on improving patient care, but when I have a 12 hr shift that is completely packed with tasks, it is kind of hard to read about new research and refresh my knowledge on protocols. It really does depress me that I can't spend time with a really sick patient because I have twenty other miscellaneous  treatments on the floor to finish in a 2 hr window if I want to be compliant with med charting standards.

I never realized when I was getting into this profession that people are lazy. Keeping patients alive is so difficult, and what's even harder is knowing that what we do is futile most of the time. So all those stat orders are just taken with a grain of salt. What's worse are the cliques that form and just let the outsiders flounder when they need help.

I need to sleep. And do a little more pondering.